Chayanin Tangwiriyasakul

Chayanin Tangwiriyasakul, Pedro Borges, Guilherme Pombo et al.

Focal deficits in ischaemic stroke result from impaired perfusion downstream of a critical vascular occlusion. While parenchymal lesions are traditionally used to predict clinical deficits, the underlying pattern of disrupted perfusion provides information upstream of the lesion, potentially yielding earlier predictive and localizing signals. Such perfusion maps can be derived from routine CT angiography (CTA) widely deployed in clinical practice. Analysing computed perfusion maps from 1,393 CTA-imaged-patients with acute ischaemic stroke, we use deep generative inference to localise neural substrates of NIHSS sub-scores. We show that our approach replicates known lesion-deficit relations without knowledge of the lesion itself and reveals novel neural dependents. The high achieved anatomical fidelity suggests acute CTA-derived computed perfusion maps may be of substantial clinical-and-scientific value in rich phenotyping of acute stroke. Using only hyperacute imaging, deep generative inference could power highly expressive models of functional anatomical relations in ischaemic stroke within the pre-interventional window.

Parhom Esmaeili, Chayanin Tangwiriyasakul, Eli Gibson et al.

Interactive segmentation enables clinicians to guide annotation, but existing zero-shot models like nnInteractive fail to consistently reach expert-level performance across diverse medical imaging tasks. Because annotation campaigns produce a growing stream of task-specific labelled data, online adaptation of the segmentation model is a natural complement to zero-shot inference. We propose CLoPA, a continual adaptation strategy that tunes a small fraction of nnInteractive's parameters on the annotation cache, triggered by lightweight episode scheduling. CLoPA requires no new parameters or changes to the inference pipeline, and operates entirely within the existing annotation workflow. Across eight Medical Segmentation Decathlon tasks spanning diverse anatomical targets and imaging characteristics, CLoPA rapidly elevates performance to expert-level, even for tasks where nnInteractive previously failed, with the majority of gains realised after a single training episode. We show that the benefits of tuning different parameter groups depends on task characteristics and data regimes. Also, that for targets with complex geometries (e.g., hepatic vessels), instance normalisation and low-level feature tuning saturates, suggesting a need for deeper feature-representation alignment in the most challenging scenarios.

Chayanin Tangwiriyasakul, Pedro Borges, Stefano Moriconi et al.

Stroke is a leading cause of disability and death. Effective treatment decisions require early and informative vascular imaging. 4D perfusion imaging is ideal but rarely available within the first hour after stroke, whereas plain CT and CTA usually are. Hence, we propose a framework to extract a predicted perfusion map (PPM) derived from CT and CTA images. In all eighteen patients, we found significantly high spatial similarity (with average Spearman's correlation = 0.7893) between our predicted perfusion map (PPM) and the T-max map derived from 4D-CTP. Voxelwise correlations between the PPM and National Institutes of Health Stroke Scale (NIHSS) subscores for L/R hand motor, gaze, and language on a large cohort of 2,110 subjects reliably mapped symptoms to expected infarct locations. Therefore our PPM could serve as an alternative for 4D perfusion imaging, if the latter is unavailable, to investigate blood perfusion in the first hours after hospital admission.